DHS, Attorney general, DA: the timeline/law school

In Feb. 2006, the KVHD skilled nursing facility failed the annual survey by DHS/CMS. Several familiar factors to the citation, was short staffing, weight loss of patients, use of physical restraints, psychotropic drugs and the need for a Director of Nursing.

In her CNO report in Feb. 2006, former CNO, Sharon Brucker, notes that the SNF is indeed making some changes and residents will be getting a better dining experience.

The report, far removed from the reality of the situation which would end up with investigations, civil suits, and indictments, was just the beginning of how mismanagement by both the hospital and the oversight would let quality of care sink to such a level.

DHS issued a concern about the licensing of the skilled nursing administrator and said that the SNF also had to have a full time Director of Nursing.

In her plan of corrections, former CEO, Pam Ott, assures DHS that they have a DON already aboard and working.

In the human resources report for the Month of Feb. 2006 there is no posted opening for a Director of Nursing. The same for March 2006.

But Ott reports in March that the new DON didn't arrive, something happened, she couldn't take the job. All sad.

In March 2006, an email, (a correspondence obtained from a former employee working in the CEO's office,) from board counsel, Scott Nave, to Pam Ott, regarding the licensing of the skilled nursing administrator was recieved.
The letter apparently answers Ott's question as to the need for a license or not. She cites confusion on the part of DHS and CMS.

Nave responds with several legal statutes that there is no license necessary.

In the April 2006, human resources report, a new opening is listed for a DON.

Several months pass, without this correction being implemented. In July 2006, DHS is back in the SNF, still battling for the other corrections promised by the CEO/administrator.

Finally in August 2006, the job listing is removed, and new DON, Gwen Hughes arrives at her new job.

Law School:

15610.65. "Reasonable suspicion" means an objectively reasonable suspicion that a person would entertain, based upon facts that could cause a reasonable person in a like position, drawing when appropriate upon his or her training and experience, to suspect abuse.

1420. (a) (1) Upon receipt of a written or oral complaint, the state department shall assign an inspector to make a preliminary review of the complaint and shall notify the complainant within two working days of the receipt of the complaint of the name of the inspector. Unless the state department determines that the complaint is willfully intended to harass a licensee or is without any reasonable basis, it shall make an onsite inspection or investigationwithin 10 working days of the receipt of the complaint. In any case in which the complaint involves a threat of imminent danger of death or serious bodily harm, the state department shall make an on site inspection or investigation within 24 hours of the receipt of the complaint. In any event, the complainant shall be promptly informed of the state department's proposed course of action and of the opportunity to accompany the inspector on the inspection or investigation of the facility. Upon the request of either the complainant or the state department, the complainant or his or her representative, or both, may be allowed to accompany the inspector to the site of the alleged violations during his or her tour of the facility, unless the inspector determines that the privacy of any patient would be violated thereby.
(2) When conducting an onsite inspection or investigation pursuant to this section, the state department shall collect and evaluate all available evidence and may issue a citation based upon, but not limited to, all of the following:
(A) Observed conditions.
(B) Statements of witnesses.
(C) Facility records.
(3) Within 10 working days of the completion of the complaint investigation, the state department shall notify the complainant and licensee in writing of the department's determination as a result of the inspection or investigation.
(b) Upon being notified of the state department's determination as a result of the inspection or investigation, a complainant who is dissatisfied with the state department's determination, regarding a matter which would pose a threat to the health, safety, security,welfare, or rights of a resident, shall be notified by the state department of the right to an informal conference, as set forth in this section. The complainant may, within five business days after receipt of the notice, notify the director in writing of his or her request for an informal conference. The informal conference shall be held with the designee of the director for the county in which the long-term health care facility which is the subject of the complaintis located. The long-term health care facility may participate as a party in this informal conference. The director's designee shall notify the complainant and licensee of his or her determinationwithin 10 working days after the informal conference and shall apprise the complainant and licensee in writing of the appeal rights provided in subdivision (c).
(c) If the complainant is dissatisfied with the determination of the director's designee in the county in which the facility is located, the complainant may, within 15 days after receipt of this determination, notify in writing the Deputy Director of the Licensing and Certification Division of the state department, who shall assign the request to a representative of the Complainant Appeals Unit for review of the facts that led to both determinations. As a part ofthe Complainant Appeals Unit's independent investigation, and at the request of the complainant, the representative shall interview the complainant in the district office where the complaint was initially referred. Based upon this review, the Deputy Director of the Licensing and Certification Division of the state department shall make his or her own determination and notify the complainant and the facility within 30 days.
(d) Any citation issued as a result of a conference or review provided for in subdivision (b) or (c) shall be issued and served upon the facility within three working days of the final determination, unless the licensee agrees in writing to an extension of this time. Service shall be effected either personally or byregistered or certified mail. A copy of the citation shall also be sent to each complainant by registered or certified mail. (e) A mini exit conference shall be held with the administrator or his or her representative upon leaving the facility at the completion of the investigation to inform him or her of the status of theinvestigation. The department shall also state the items of noncompliance and compliance found as a result of a complaint and those items found to be in compliance, provided the disclosure maintains the anonymity of the complainant. In any matter in which there is a reasonable probability that the identity of the complainant will not remain anonymous, the state department shall also notify the facility that it is unlawful to discriminate or seek retaliation against a resident, employee, or complainant.
(f) For purposes of this section, "complaint" means any oral or written notice to the state department, other than a report from the facility of an alleged violation of applicable requirements of state or federal law or any alleged facts that might constitute such a violation.

15610.07. "Abuse of an elder or a dependent adult" means either of the following: (a) Physical abuse, neglect, financial abuse, abandonment,isolation, abduction, or other treatment with resulting physical harm or pain or mental suffering.
(b) The deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering.


1418.91. (a) A long-term health care facility shall report all incidents of alleged abuse or suspected abuse of a resident of the facility to the department immediately, or within 24 hours.
(b) A failure to comply with the requirements of this section shall be a class "B" violation.
(c) For purposes of this section, "abuse" shall mean any of the conduct described in subdivisions (a) and (b) of Section 15610.07 ofthe Welfare and Institutions Code. (d) This section shall not change any reporting requirements under Section 15630 of the Welfare and Institutions Code, or as otherwise specified in the Elder Abuse and Dependent Adult Civil Protection Act, Chapter 11 (commencing with Section 15600) of Part 3 of Division9 of the Welfare and Institutions Code.

Okay, students of KVHD, how do these laws apply to what happened in 2006-2007 in the skilled nursing facility?